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- Title
A Study of Combined Surgery in Control of Atonic PPH During Caesarian Section and its Outcome.
- Authors
Girija, B. S.; Raju, V. S.
- Abstract
Source: Department of Obstetrics & Gynecology, JJM Medical College Davanagere & Hassan Institute of Medical Sciences, Hassan, Karnataka, India. Objective: Atonic postpartum haemorrhage during caesarian delivery which was not controlled with oxytocics were managed with conservative procedures like Bilateral uterine artery ligation & modified B-lynch brace suture application. Outcome of the procedure in terms of control of PPH, post operative complications & subsequent reproductive health outcome were studied. Method: The paper explains the combined approach of uterine artery ligation along with modified B-lynch brace suture application in atonic uterus during caesarian section when medical measures failed. Since uterine atony is the main reason for excessive & uncontrollable haemorrhage after child birth, need to perform such surgery is rather common. Combined approach is more effective in controlling atonic PPH. Results: Out of 25 cases in the study group, which were managed by conservative surgical procedure like Bilateral uterine artery ligation & modified B-lynch brace suture application for atonic PPH following caesarian delivery, 24(96%) had control of PPH, 1(4%) case had failure of the procedure & ended with hysterectomy due to cardiovascular instability. Postoperatively there were no complications & there was normal involution of the uterus. Out of 25 cases, 12(48%) cases attempted conception, 4(33%) of them conceived. 2 of them had repeat LSCS during which no uterine cavity abnormality was found. Other 2 had vaginal birth after caesarian section.5 cases underwent tubal ligation along with caesarian section. 8 patients were lost for follow up. Out of 17 cases followed up, none of them had menstrual abnormality. Conclusion: Atonic PPH not responding to medical line of treatment can be effectively controlled with judicious & timely application of conservative combined approach like bilateral uterine artery ligation & modified B-lynch brace suture application. This procedure is easy to perform, which can avoid peripartum hysterectomy & retain the uterus for future fertility & menstrual function.
- Subjects
CESAREAN section; HEMORRHAGE; PUERPERIUM; OPERATIVE surgery; REPRODUCTIVE health; HYSTERECTOMY
- Publication
Indian Journal of Public Health Research & Development, 2014, Vol 5, Issue 1, p174
- ISSN
0976-0245
- Publication type
Article
- DOI
10.5958/j.0976-5506.5.1.039